American Indian and Alaska Native women have high breast cancer mortality rates compared to U.S. women of other races. The Center for Disease Control and Prevention provides funding through 13 tribal programs as part of its Breast and Cervical Cancer Early Detection Program for free mammography screening to American Indian and Alaska Native women. The program mandates that 75 percent of the funding provided is used to screen American Indian and Alaska Native women 50 years of age and older to diagnose tumors at an earlier stage and improve health outcomes. However, despite the availability of free breast cancer screening services provided to many tribal communities, American Indian and Alaska Native women have low rates of mammography use and the poorest 5-year survival from breast cancer of any racial/ethnic group. Even more alarming, American Indian and Alaska Native women 50 years of age and older do not take advantage of early cancer detection opportunities, despite being a subpopulation at very high risk for breast cancer. This is of particular concern because mammography technology is more accurate in older than younger women, increasing the chances of early cancer detection, less invasive treatment, and better survival outcomes. Little information exists about why older American Indian and Alaska Native women do not use free mammogram services through tribal-run Breast and Cervical Cancer Early Detection Programs. Factors that may influence older women's receipt of annual screening mammograms include generational differences in cancer prevention education and lack of age-specific, culturally appropriate mammography screening awareness campaigns directed at elders. The purpose of this proposal is to conduct a needs assessment in American Indian and Alaska Native communities using qualitative research methods to identify issues that deter older women from receiving mammograms. Thus, the Specific Aims of this research effort are to 1) identify issues that prevent older American Indian and Alaska Native women from receiving annual mammograms from the perspective of staff representing the 13 tribal Breast and Cervical Cancer Early Detection programs, and 2) identify issues that prevent older women from receiving annual mammograms from the perspective of American Indian and Alaska Native women aged 50 years and older. The proposed qualitative research study will be conducted in two phases. Phase I will involve key informant interviews with program staff directly working in each of the 13 tribal CDC programs regarding issues they perceive influence receipt of free mammography screening by eligible older women. In Phase II, we will conduct focus groups in collaboration with three tribal programs to explore the needs, concerns, knowledge of risk, beliefs, and attitudes of American Indian and Alaska Native women at least 50 years of age about mammography screening and breast cancer prevention. Results will be used to design more effective outreach and intervention programs that will increase mammography screening among older women and reduce American Indian and Alaska Native breast cancer mortality. [unreadable] [unreadable] [unreadable]